Provider Demographics
NPI:1588633192
Name:MALANI, BRIJMOHAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIJMOHAN
Middle Name:
Last Name:MALANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 4363
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4363
Mailing Address - Country:US
Mailing Address - Phone:773-334-4145
Mailing Address - Fax:773-334-0444
Practice Address - Street 1:2335 W FOSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1843
Practice Address - Country:US
Practice Address - Phone:773-334-4145
Practice Address - Fax:773-334-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052869Medicaid
ILD13101Medicare UPIN